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Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
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临界神经疾病的预后语言:一个多中心混合方法研究

Adeline Goss1, Connie Ge2, Sybil Crawford1

  • 1From the Division of Neurology (A.G.), Department of Internal Medicine, Highland Hospital, Oakland, CA; Department of Neurology (C.G., K.G.), and Tan Chingfang Graduate School of Nursing (S. Crawford), University of Massachusetts Chan Medical School, Worcester; Department of Critical Care Medicine (P.B., D.B.W.), University of Pittsburgh School of Medicine, PA; Division of Pulmonary, Allergy, and Critical Care Medicine (C.L.H.), Department of Medicine, Oregon Health & Science University, Portland; Department of Medicine (B.L.), University of California San Francisco; Division of Pulmonary and Critical Care Medicine (S. Carson), Department of Medicine, University of North Carolina Hospitals, Chapel Hill; Division of Pulmonary Medicine and Critical Care Medicine (J.S.), Department of Internal Medicine, University of Massachusetts Chan Medical School-Baystate, Springfield; and Departments of Neurology, Anesthesia/Critical Care, and Surgery (S.M.), University of Massachusetts Chan Medical School, Worcester.

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科学领域:

  • 神经学 神经学
  • 关键护理医学 关键护理医学
  • 医学沟通 医学沟通

背景情况:

  • 缺乏基于证据的指导方针来讨论关键神经疾病的预后.
  • 专家建议使用估计 (数值或定性) 进行预后沟通.
  • 现实世界临床医生在传播关键神经疾病的预后方面的实践尚未得到充分理解.

研究的目的:

  • 描述临床医生在关键神经疾病中使用的预后语言.
  • 探索各种预测领域 (如生存,认知) 的预测语言的差异.

主要方法:

  • 一项多中心,横截面,混合方法的研究分析了临床医生和家属会面的音频记录,用于重症神经病患者.
  • 预测陈述根据语言类型 (概率与非概率) 和领域 (生存,身体功能,认知,整体恢复) 编码.
  • 统计分析,包括后勤回归,检查了预后语言和域之间的关联.

主要成果:

  • 大多数预后陈述 (62%) 是非概率的;只有2%提供了数值估计.
  • 关于生存和身体功能的陈述比关于认知的陈述更频繁地是概率性的.
  • 预测语言因领域而异,认知结果最不可能使用概率术语来讨论.

结论:

  • 临床医生倾向于避免使用估计在关键神经疾病的预后沟通时,特别是关于认知结果.
  • 研究结果表明,需要进行干预措施,以改善这种患者群体的预后沟通.